熱中症の実態調査 - jaam.jp

1 heatstroke STUDY 2006 . 1 1 2 3 4. 5 6 6 7 . 18 6-8 66 528. 3-93 413 113 2 .. I 62% II 18% III 20% . 25 47 59 3 . 7 8 1 . 11 15 Japan coma scale: JCS 0/JCS . 43% =I . 1/JCS 15% =II . 2-300/JCS 42% =III 61% 12% 27% . 285 38 221. 51 90mmHg 120/min 39 C . ALT 240 IU/l 98 IU/l . DIC 13 .. 2 13 III . 90mmHg 120/min 40 C pH< .. 8 62% .. 2008 19 309-21 .. 1) .. 18 .. 6-8 . heatstroke STUDY 2006 in Japan .. 1.. 2 3 . 4 5 . 6 7 1.. 2006 6 8 3 . 142-8666 1-5-8. 2008 2 27 08-015 . 2008 19 309-21 309.. Table 1a. Prearranged format for prehospital data accumuration Table 1b. Prearranged format used in the hospital to collect (original). clinical data of heatstroke patients (original).. 14 . Table 1a . 3) . Table 1b .. 2). Fig. 1 .. 310 JJAAM 2008 19 309-21. heatstroke STUDY 2006. Grade Signs and symptoms Severity Fluid Former replacement classification and therapy (reference).

2 Dizziness Usually no need for heat syncope streaming perspiration admission heat cramp syncope muscle pain oral fluid intake and muscle cramp rest headache, exhaustion Need for hospital- heat exhaustion nausea, vomiting, ization to take intra- abdominal pain, diarrhea venous fluid re- confusion, placement and ob- No abnormality in blood test except servation for creatinine kinase Any of three clinical dysfunctions Need for intensive heatstroke below care against cardiac, (1) central nervous system hepatic, renal, and coma, seizure, cerebellar sign hematological dys- (2) renal and hepatic function functions elevation of ALT, AST, BUN, and creatinine (3) Haematological system Diagnosis of disseminated intra- vascular coaglation Fig. 1. New classification for heat illness. ALT: alanine aminotransferase, AST: asparate aminotransferase, BUN: blood urea nitrogen 2.

3 III . 10 50-60 . 2 . 2 2 student-t . Fig. 3 . 3 .. Fig. 4 .. 66 528 . 413 113 2 . 4 3-93 . p< .. 481 Fig.. 2a Fig. 2b 403 . 60% I 352 . II 82 . 2008 19 309-21 311.. 62% 18% 20%. Grade I (298 cases) Grade II (87 cases). Grade III (96 cases). Fig. 2a. Number of heatstroke patients classified by the new classification (481 cases). Number of patients 90. 80 Grade III. 70 Grade II. 60 Grade I. 50. 40. 30. 20. 10. 0. 0 10 20 30 40 50 60 70 80 90 Age (years). Fig. 2b. Number of patients by age and severity. Number of patients 90. Male 80 Female 70. 60. 50. 40. 30. 20. 10. 0. 0 10 20 30 40 50 60 70 80 90 Age (years). Fig. 3. Patients by age and sex. 312 JJAAM 2008 19 309-21. heatstroke STUDY 2006. Number of patients 180. 160 outdoor 140 in the shade 120 indoor 100. 80. 60. 40. 20. 0. in exercise in physical labor in ordinary life Male Female 110 28 206 25 86 58.

4 Age (years) * *. Age data are expressed as means standard deviation * Significant with a p value < Fig. 4. Number of patients by situation. Number of patients 250. III . 200. II . I . 150. 100. 50. 0. Middle End of Early of Middle End of Early of Middle End of of June June July of July July Aug. of Aug. Aug. Fig. 5. Number of patients by 10 days. 50 11 15 . 6 8 10 .. Fig. 5 . 6 . 7 8 2 90mmHg . 8 10% 120/min . 1 12 15- 20% . 16 2 Fig. 6 30% I . 119 / II . 2008 19 309-21 313.. Number of patients 45. 40. 35. 30. 25. 20. 15. 10. 5. 0. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23. Arrival time (o'clock) at the scene Fig. 6. Number of patients by the arrival time of Emergency Service. 2-300/JCS [Grade III] 2-300/JCS [Grade III]. 0 0. 1 1. 2 2. 3 3. 0/JCS [Grade I] 10 10-30. 20 100. 30 1/JCS 200. [Grade II] 0/JCS [Grade I].

5 100 300. 200. 300. 1/JCS [Grade II]. Fig. 7a. Consciousness at the scene classified by Japan coma Fig. 7b. Consciousness on admission classified by Japan coma scale (JCS). scale (JCS). Grade I heatstroke patients have no consciousness disturbance Grade I heatstroke patients have no consciousness disturbance (=0/JCS). (=0/JCS). Grade II heatstroke patients reveal slight disturbance of con- Grade II heatstroke patients reveal slight disturbance of con- sciousness (=1/JCS). sciousness (=1/JCS). Typical conscious disturbance with a severity of 2-300/JCS co- Typical conscious disturbance with a severity of 2-300/JCS co- incides with Grade III heatstroke . incides with Grade III heatstroke . Japan coma scale JCS . 30% Fig. 7a, 7b .. 0/JCS I 1/JCS II . 215 40% 338 III 0/. 75% . 12 JCS 43% 1/JCS 15% 42% . 4 2 61% 12% 27% . 314 JJAAM 2008 19 309-21.

6 heatstroke STUDY 2006. Number of patients 200. 175 Grade I heatstroke Grade II heatstroke 150 Grade III heatstroke 95. 100. 71. 62. 50. 12 10 16 13 10. 2 6 6. 0. ambulance on foot private car from other hospital Fig. 8. heatstroke severity (Grade I-III) on admission by means of transport. thirst inpatient outpatient dizziness muscle cramp muscle pain exhaustion consciousness disturbance 0 50 100 150 Number of patients Fig. 9. Chief complaints and indication for hospitalization. 0/JCS Fig. 9 I .. 300/JCS II . 71% . Fig. 8 78% . 0/JCS 84% 1/JCS . 0/JCS 34% 1-3/JCS 10-30/JCS . 100-300/JCS Table 2 . III .. I . DIC ALT . 2008 19 309-21 315.. Table 2. Characteristics of heatstroke patients by indication for hospitalization. Outpatients Inpatients (n=285) (n=221). No. of male/female 225 60 171 50. Average age (years) No. of patients (%).

7 0-1/JCS* 260 ( ) 101 ( ). blood pressure 90mmHg* 3 ( ) 25 ( ). heart rate 120/min* 15 ( ) 75 ( ). body temperature C* 18 ( ) 56 ( ). Platelet count < 50,000/ l 0 5 ( ). ALT 50 IU/l 22 ( ) [mean 98] 45 (20%) [mean 240]. meet the criteria of DIC 1 13. *: Significant with a p value< in the number of patients who meet the symptom between two groups JCS: Japan coma scale, ALT: alanine aminotransferase, DIC: disseminated intravascular coagulation CRP 90mmHg . CK BUN/Cre 9 13% . 120/min 51. 150/min 23 45% . 76% . 20% 0-3/JCS 19 C 100-300/. JCS 31 C ALT. 0-1/JCS 90mmHg 104 IU/l 370 IU/l CK . 120/min 39 C 2,538mg/dl vs 1,823mg/dl .. p< CPA 1 . III 83 1 11 . II 54 I 48 6 5 . Fig. 10a I 10/JCS 1 300/JCS . II III 90mmHg 90% 120/min 90% . 150/min 44% 40 C. 2 75% 40 C III . I 2 1 . II 11 2 300/JCS 90mmHg 40 C pH< . I II III p<.

8 ALT . 13 10 2 p< .. 4 . 2 2 3 3 2 . 3 4 2 10 13 CHDF 7 . 16 Fig. 10b HD 7 PE 1 . III B PMX-DHP 7 . Table 3 . III 80 DIC 12 . 67 13 7 III . 54 13 4 . 316 JJAAM 2008 19 309-21. heatstroke STUDY 2006. outpatients Grade III. inpatients Grade II. Grade I. 0 50 100 150 200 250 Number of patients Fig. 10a. Severity of outpatients and inpatients. Number of patients 25. Grade I. 20. Grade II. 15. Grade III. 10. 5. 0. 1 3 5 7 9 11- days Fig. 10b. Length of hospital stay by severity. Table 3. Comparison between survivor with nonsurvivor among Grade III inpatients. Survivor Nonsurvivor No. of patients 67 11. male female 54 13 6 5. average age (range) [years] (12-93) (29-81). 300/JCS on admission* 24% 90%. BP 90mmHg* 13% 90%. HR 120/min+ 76% 90%. BT 40 C* 32% 75%. pH < * 23% 73%. ALT 50 IU/l+ 33% (mean 104) 64% (mean 370). CK 200 IU/l 75% (mean 2,538) 73% (mean 1,823).

9 BUN / Cre 22 24% 54%. *: Significant with a p value < in the numbers with the symptom between two groups. +. : Significant with a p value < in the collected data (heart rate/min and serum ALT) between two groups. 1 DIC 1 . 9 144 . 142 65 . 77 . 10 4 . 11 8 I 21 II 10 III 33 I 40 II . 2008 19 309-21 317.. 15 III 11 . 16 . 9 8 7 . 4 . 35% 11 4 8 1 11 15 . 3 3 2006 . 3 4) 7 8 . III 6 III 2 . 62% 90% . 7 4 . 1 .. 1999 . 2) .. I . I II III 1 . / . 2002 / .. 3) .. / . I II III . III 20% 2 . 2 .. HP . 18 17 5) . 318 JJAAM 2008 19 309-21. heatstroke STUDY 2006. 20-50 . 1 2 .. I II 1 2 . III .. 75% 2 . 40 C .. H2O .. 100 ml Na 46-49mg K 10% . 8-24mg 5-7g Na K . oral rehydration solusion . 100ml Na 115mg K 78mg 6) . 500ml 3-4 : classical heatstroke . 7) K .. I 25% II . 13% .. / 2. acclimatization . 1 1 .. II .. 8) . heat island III.

10 DIC . 2008 19 309-21 319.. fever hyperthermia 1 II . CRP 3 17 .. 35 . 2007. 10 . 35 2008 2.. 2008 6 . Geriatric Medicine . 13 200-300 46 6 . 9).. 66 . 320 JJAAM 2008 19 309-21. heatstroke STUDY 2006. 5) 18 . 0510001 . 1) 19 5 10 roudoukijun/anzeneisei16 2) 6) Centers for Disease Control and Prevention: MMWR 2003;. I III 52 ( ): 1-16. 1999; 23: 1119-23. 7) JAPIC. 3) 2008 2007 p575. 8) Bouchama A, Dehbi M, Mohamed G, et al: Prognostic fac- 2004; 17: 58-63. tors in heat wave related death: a meta-analysis. Arch Intern 4) Med 2007; 167: 2170-6. 9) 1968 2006 .. 2008 . ABSTRACT. heatstroke STUDY 2006 in Japan Yasufumi Miyake, Tohru Aruga, Kenichiro Inoue, Hiroshi Okudera, Takao Kitahara Shuji Shimazaki, Ryosuke Tsuruta, Tsuyoshi Maekawa, and Hiroyuki Yokota heatstroke Surveillance Committee of Japanese Association for Acute Medicine Objective: The authors have investigated the characteristics of heatstroke patients transported into the emergency medical centers or emergency departments in Japan.